Healthcare Provider Details

I. General information

NPI: 1316949183
Provider Name (Legal Business Name): THOMAS HEGEMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BORSHWICK AVENUE PORTSMOUTH ANESTHESIA ASSOCIATES
PORTSMOUTH NH
03801-7128
US

IV. Provider business mailing address

PO BOX 845343 PORTSMOUTH ANESTHESIA ASSOCIATES
BOSTON MA
02284-5343
US

V. Phone/Fax

Practice location:
  • Phone: 603-749-0043
  • Fax:
Mailing address:
  • Phone: 800-720-1664
  • Fax: 207-753-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0232832311
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number023283-23-11
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number023283-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: